SCO Members Must Enroll in Medicare to Keep Their Coverage

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Significant changes to SCO and MassHealth eligibility will take effect on January 1, 2026.

Starting January 1, 2026, MassHealth will require members to be enrolled in Medicare to qualify for enrollment in a SCO plan. MassHealth members aged 65 and older who are eligible for Medicare at no cost (also called Qualified Medicare Beneficiaries) must apply for and obtain Medicare coverage to remain enrolled in their plan and retain their MassHealth coverage after December 31, 2025. SCO members who already have both Medicare and MassHealth will not be impacted by this change.

 

What is a Qualified Medicare Beneficiary?  

Qualified Medicare Beneficiaries (QMB) are MassHealth members who qualify for a Medicare Savings Program (MSP) i that helps pay for Medicare costs like premiums, deductibles, and copays. MassHealth (Medicaid) will cover these costs for QMB members. This means QMB members don’t have to pay out-of-pocket to get Medicare coverage. This will continue as long as the member remains eligible for the same type of MassHealth coverage.

 

Members must take action to enroll in Medicare 

MassHealth members eligible for Medicare at no extra cost are required to enroll in Medicare. If these members do not enroll in Medicare, they may lose MassHealth and SCO coverage.  

  • MassHealth-only members will no longer be eligible for SCO after 12/31/2025.  
    • Current SCO members who are not eligible for Medicare will be disenrolled from SCO after 12/31/2025 and retain only their MassHealth coverage.
    • Current SCO members who are eligible for Medicare (QMB) and do not have both Medicare Part A and B by 12/31/2025 will lose their SCO and MassHealth coverage.
  • Current SCO members with both Medicare and MassHealth will not be impacted by this change and their coverage will continue.

To begin the Medicare application process, members must schedule an appointment with the Social Security Administration (SSA). 

 

Schedule an appointment to apply for Medicare

Members must call or visit their local Social Security Administration Field Office directly to request an application appointment. They can also contact us at 1-855-670-5934 (TTY 711) for help scheduling a Medicare appointment with their local Social Security Administration office.

  • Local SSA Field Offices can be located online by zip code at https://secure.ssa.gov/ICON.main.jsp
  • Call the national SSA line at (800) 772-1213
  • Set up a telephone or in-person appointment based on the member’s preference (QMBs are not eligible to apply for Medicare online)
  • Request an interpreter for the appointment if needed
  • Please note: When speaking with SSA, use the term “Medicaid member” instead of “MassHealth member.” The Social Security Administration is not always familiar with MassHealth and may deny your appointment request.

 

Prepare for the Medicare appointment

Members should be prepared to provide this information when scheduling an appointment with SSA:

  • Social Security Number
  • Date of Birth
  • Full Name
  • Mailing Address
  • Country of Birth
  • Marital Status (single, married, divorced, widowed)
  • Your reported citizenship or permanent resident status
  • Phone number SSA should use to contact you for the appointment
  • Any other documents that the SSA asks for

 

What do I need to bring to my Medicare application appointment?  

When members go to their Medicare application appointment, they can show the Social Security Office the linked “Information for the Social Security Office” document [DOWLOAD THE PDF DOCUMENT HERE] This document explains that the member is a Qualified Medicare Beneficiary who is required to enroll in Medicare. This will help them process the application correctly. If attending the Medicare appointment over the phone, members should tell them what this document says.

 

More information to come

Members should keep an eye out for communications from our team or community partners, who may be reaching out to help them with this process.  

 

Contact us

Call Member Services at 1-855-670-5934 (TTY 711). Representatives are available from 8:00 a.m. to 8:00 p.m., 7 days a week from October 1 to March 31 and Monday – Friday from April 1 to September 30.  

 

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